An Interventional, Efficacy, and Safety, Phase 3 Randomized, Double-Blind, Placebo-Controlled Study with an Open-Label Extension to Investigate Rimegepant in Migraine Prevention in Adolescents 12 to Less Than 18 Years of Age with Chronic Migraine

Overview

Sponsor-declared trial summary

Key facts

Sponsor

Pfizer Inc.

Participant type

Pediatric, Patients

Age range

0-17 years

Gender

Male and Female

Therapeutic area

Diseases [C] - Nervous System Diseases [C10]

Trial duration

22 Apr 2025 → ongoing

Decision date (initial)

2024-10-21

Transition trial

No

Low-intervention

No

Rare-disease indication

No

Vulnerable population

Yes

Trial design

CTIS Part I — objectives, methods, condition coding

Main objective

Scope: Efficacy, Safety

To compare the efficacy of rimegepant to placebo as a preventive treatment for migraine in adolescents with chronic migraine.

Secondary objectives 7

1. To compare the use of acute migraine-specific medications between rimegepant and placebo in adolescents with chronic migraine.
2. To further compare the efficacy of rimegepant to placebo in adolescents with chronic migraine.
3. To compare the change from baseline in the PedsQL™ total score between rimegepant and placebo in adolescents with chronic migraine.
4. To compare the use of acute headache medications and acute migraine-specific medications between rimegepant and placebo in adolescents with chronic migraine.
5. To evaluate the safety and tolerability of rimegepant as a preventive treatment for migraine in adolescents with chronic migraine.
6. To evaluate the frequencies of hepatic-related AEs and hepaticrelated AEs leading to study intervention discontinuation in adolescents with chronic migraine.
7. To compare the change from baseline in the Pediatric Migraine Disability Assessment (PedMIDAS) total score between rimegepant and placebo in adolescents with chronic migraine

Conditions and MedDRA coding

Chronic Migraine

Study design 2 periods

Regulatory references

Scientific advice from competent authorities

Food And Drug Administration

Plan to share IPD

Yes

IPD plan description

Pfizer will provide access to individual de-identified participant data and related study documents (e.g. protocol, Statistical Analysis Plan (SAP), Clinical Study Report (CSR)) upon request from qualified researchers, and subject to certain criteria, conditions, and exceptions. Further details on Pfizer's data sharing criteria and process for requesting access can be found at: https://www.pfizer.com/science/clinical_trials/trial_data_and_results/data_requests.

Eligibility criteria

Principal inclusion / exclusion criteria as submitted by sponsor

Inclusion criteria 3

1. Age and Sex: 1. Participants aged 12 to <18 years at the time of signing assent/consent. Participants must not reach their 18th birthday on or before the Randomization (Baseline) visit. • For EU countries and India ONLY: Participants must weigh greater than 40 kg
2. Disease Characteristics: 2. Participant has at least a 6-month history of migraine (with or without aura) consistent with a Diagnosis according to the International Classification of Headache Disorders, 3rd Edition1 including the following: • 15 or more headache days per month during the 3-month period prior to the Screening Visit. • 8 or more migraine days per month during the 3-month period prior to the Screening Visit. • 15 or more headache days during the OP. • 8 or more migraine days during the OP. • Ability to verbally distinguish migraine attacks from tension/cluster or other types of headaches. • Migraine attacks, on average, lasting 4 to 72 hours if untreated.
3. Other Inclusion Criteria: 3. Signed Written Informed Consent: • The participant is able to understand the Informed Assent Document (IAD) and the participant’s parent(s)/legal representative(s) (according to local regulations) are/is able to read and understand the Informed Consent Document (ICD). • The participant has signed the IAD/ICD (according to local regulations) and the participant’s parent(s)/legal representative(s) have/has signed the ICD prior to the conduct of any study-specific procedures. • The participant must be able to read and comprehend written instructions and be willing to complete all questionnaires under supervision of legal representative(s) as required by the protocol.

Exclusion criteria 10

1. Target Disease Exclusion: • Continuous migraine (defined as an unrelenting headache) within 1 month prior to Screening Visit. • Atypical migraine types, complications of a migraine, or a confounding and clinically significant pain syndrome that may interfere with the participant’s ability to participate in this study as assessed by the principal investigator (PI).
2. Any medical condition or laboratory abnormality, including any clinically significant out-of-range vital signs, that may increase the risk of study participation or, in the investigator’s judgment, make the participant inappropriate for the study (see Exclusion #10 for key parameters assessments for liver and renal function, and for cardiac evaluation).
3. Any current psychiatric condition that is uncontrolled and/or untreated.
4. Any “yes” response on the C-SSRS for the period of 30 days prior to Screening.
5. History of alcohol abuse and/or illicit drug use meeting DSM-5®² criteria for substance use disorder within 6 months of screening (excluding nicotine and caffeine). • Positive at screening for drugs of abuse, and who are on a prescribed medication for an approved indication (eg, ADHD), will be allowed into the study at the investigator’s discretion. This determination by the investigator must be well documented in the source medical records. The stimulant dose must be stable from 3 months prior to baseline until the end of treatment visit occurs.
6. History of severe drug allergy (such as anaphylaxis, or known hypersensitivity or intolerance to rimegepant or its excipients).
7. Current use of any prohibited concomitant medication(s).
8. More than 1 medication taken for migraine prevention/prophylaxis. • Concomitant use of a CGRP receptor antagonist, such as Nurtec™ or others, monoclonal antibodies such as erenumab, fremanezumab, or others <6 months prior to the Screening Visit. • Prophylactic migraine medication discontinued less than 30 days prior to the Screening Visit. • Prophylactic migraine medication not being stable for at least 3 months (12 weeks) prior to the OP, or dose expected to change during the course of the study.
9. Previous administration with an investigational product (drug or vaccine) within 30 days (or as determined by the local requirement) or 5 half-lives preceding the first dose of study intervention used in this study (whichever is longer). Participation in studies of other investigational products at any time during participation in this study is also exclusionary.
10. The following laboratory/electrocardiogram (ECG) values are exclusionary during the screening period: • Estimated glomerular filtration rate (eGFR)/creatinine clearance (CrCl) <45 mL/min/1.73m2. • Serum total bilirubin > upper limit of normal (ULN) (unless participant has known or suspected Gilbert’s Syndrome). • Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >2 x ULN (AST and/or ALT may be repeated once during the Screening period for assessment of eligibility). • An abnormal ECG at the screening visit that is clinically significant based on the investigator’s evaluation of the central reader’s interpretation. Determinations of eligibility based on QT interval will be based on the Fridericia correction where QTcF= QT/(RR⁰.³³).

Endpoints

Primary and secondary outcome measures (English text)

Primary endpoints 1

1. Mean change from the observation phase (OP) in the number of migraine days per month over the entire double-blind treatment (DBT) Phase (Weeks 1 to 12).

Secondary endpoints 8

1. Mean change from the OP in the number of acute migraine-specific medication days per month over the entire DBT Phase (Weeks 1 to 12).
2. Mean change from the OP in the number of moderate or severe headache days per month over the entire DBT Phase (Weeks 1 to 12).
3. Percentage of participants with ≥50% reduction from the OP in the number of moderate or severe migraine days per month over the entire DBT Phase (Weeks 1 to 12).
4. Mean change from baseline in the PedsQL™ 4.0 Generic Core Scales total score at Week 12 of the DBT Phase.
5. Mean change from the OP in the number of acute headache medication days per month and acute migraine-specific medicationdays per month in each month and over the entire DBT Phase.
6. The number and percentage of participants with adverse events (AEs), serious adverse events (SAEs), AEs leading to study intervention discontinuation and grade 3 to 4 laboratory test abnormalities on treatment during the DBT and open-label extension (OLE) Phases.
7. The number and percentage of participants with hepatic-relate AEs and hepatic-related AEs leading to study intervention discontinuation on treatment during the DBT and OLE Phases.
8. Mean change from baseline in the PedMIDAS total score at Week 12 of the DBT Phase.

Investigational products

Investigational medicinal products (IMPs), comparators, placebo, auxiliary

Test 1

Placebo 1

Sponsors and contacts

Sponsor organisations, regulatory contacts, third parties

Pfizer Inc.

Sponsor organisation

Pfizer Inc.

Address

66 Hudson Boulevard East

City

New York

Postcode

10001-2189

Country

United States

Scientific contact point

Organisation

Pfizer Inc.

Contact name

Clinical Medical Lead

Public contact point

Organisation

Pfizer Inc.

Contact name

Clinical Medical Lead

Third parties 3

Locations

7 EU/EEA countries · 47 investigational sites

By country

Investigational sites

Country notifications

Trial-start, recruitment-start, end and early-termination notifications submitted per Member State

Results and documents

Annex IV summary of results, Annex V layperson summary, and all documents registered in CTIS for this trial

Documents 182 files

Public protocol annexes, IB summaries, regulatory submissions and post-authorisation documents registered in CTIS.

Application history

5 submissions — initial application plus substantial / non-substantial modifications